How has the armed forces ideals of leadership changed in recent years?

Norsk sammendrag Denne oppgaven omhandler endringer i Forsvarets ledelsesidealer over tid i rammen av begrepene tillitt og kontroll. Spesielt rettes fokus på hvilken effekt endringsdriverne traumatiske hendelser, forvaltningspolitisk utvikling og internasjonalisering har hatt/påvirket utviklingen. Oppgaven bygger på en tanke om at disse tre har hatt stor påvirkning på utviklingen av ledelsesidealene og søker å forstå hvorvidt disse har forsterket hverandre, eller trukket i ulik retning. Gjennomgående i oppgaven nyttes de ulike utgavene/revisjonene av Forvarssjefens grunnsyn på ledelse, som en tidsvitnebeskrivelse av ulike ledelsesidealer i aktuelle tidsperiode. De tre endringsdriverne er representert ved henholdsvis; Vassdalen-ulykken, reformer inspirert av New Public Management, og endringen i Forsvarets internasjonale innsats, fra en vekting mot FN og fredsbevarende, til en vekting mot NATO og fredsopprettende. For å identifisere mulige sammenhenger mellom endringsdriverne, og hvordan disse har påvirket ledelsesidealene i Forsvaret, trekkes det på aspekter fra organisasjonsteorier om instrumentelle og institusjonelle syn på organisasjoner og endring. En rød tråd har gått i diskusjonen om Forsvarets ledelsesideal. Fra tidlig 1900-tallet frem til nyere tids Norske adopsjon av Auftragstaktik gjennom Oppdragsbasert ledelse. I denne perioden fungerte Vassdalen-ulykken som en katalysator for hurtigere endring. Videre identifiseres komponenter fra New Public Management som forsterker naturlig utvikling, men også inneholder forvaltningspolitiske krav som bryter med den mer rendyrkede militære ledelsesfilosofien.Engelsk sammendrag (abstract) This master's thesis adressess how the Norwegian Defence Forces leadership-ideal has changed over time, in a context of the terms trust and control. Special emphasis is placed on how the drivers of change; traumatic events, changes in policies on governance, and internationalization, has affected the development. The thesis is founded on assumption that these three have had a big impact on the development of leadership ideals and seeks to understand if these have reinforced one-another or have worked against each other. The Chief of The Armed Forces fundamental view on leadership, in its different versions, will be used to highlight core principles of leadership that were dominant throughout the given time period. The three drivers of change are represented by: The Vassdalen avalanche accident, reforms influenced by New Public Management, and the change in the Norwegian Defence Forces contributions to international operations, from UN peacekeeping operations to NATO and peace-enforcement. To highlight the relation between the drivers, and how these have influenced the leadership ideals in the Armed Forces, this thesis has used the organisational theories of instrumental and institutional views on organisations and their changes. This thesis shows that there is a golden thread in the discussion of armed forces leadership. From the early 1900s until the more recent adoption of Auftragstaktik in Norwegian form (Mission based leadership). The Vassdalen avalanche incident was a catalyst contributing to the rapid change in the forementioned development. In continuation this thesis finds that elements of New Public Management both work in tandem with – but also contradicts more pure military leadership ideals

Faktorer som virker inn ved frafall i døgnbehandling for pasienter med ruslidelser. En case studie med vekt på både pasient- og behandlerperspektivet

Factors affecting dropout from residential treatment for patients with substance use disorders. A case study with emphasis on both patient and clinician perspectivesRetention in substance abuse treatment is one of the most consistent predictors of successful treatment. Despite dropout rates from 17-57% for inpatient treatment, little is known of potential risk factors related to treatment programs and processes. The aim of this study is to obtain knowledge of this phenomenon by studying underlying processes and conditions associated with dropout. The Case study method is chosen because of the scant literature and the ability of this method to gain in-depth information. The data material consists of qualitative interviews of patients and clinical staff together with journal material. The results indicate complex conditions associated with attrition and that the patients left treatment despite positive experiences and perceived usefulness of the program. It is suggested that there might be a process prior to the decision of leaving and that special attention should be paid to patients at higher risk for dropout

Assessing patients for optimal treatment by utilising and testing ASAM Criteria for substance use disorder and co-occurring psychiatric disorders Validity of ASAM Criteria

The main purpose of this dissertation was to investigate ASAM Criteria software revised version for predictive and convergent validity by assessing patients with a substance use disorder to optimal level of care (LOC). The dissertation combines one unpublished pilot study and three main papers. The pilot study is based on a satisfaction survey (n=8) and interrater reliability testing of patient videos (n=5) and assessors’ agreement. The validation study has a prospective naturalistic double-blind multi-site design and the three papers are based on data from a structured baseline interview (n=261) and follow-up interview (n=153) three months after treatment initiation. They were recruited from 10 different centres in the midregion of Norway. The private and public treatment facilities included in this dissertation cover the specialised treatment for substance use disorders in the region, with detoxification services, outpatient, inpatient and residential treatment both short and long-term. Opioid Maintenance treatment is also included, and can be given in either outpatient or inpatient setting depending on patients’ needs. The public clinic follows a biopsychosocial approach for understanding and treatment of substance use disorders which includes a variety of services. Interventions include, for example, motivational interviewing, individual or group therapy sessions, family therapy, cognitive therapy, milieu therapy, social skills training, vocational training, physical training and many more. The various services provided in this region clearly show the complexity in providing treatment for this disorder, and the need for thorough assessment before placing patients at a specific LOC. The services are closely connected to or in direct cooperation with the municipalities covering housing and occupational needs. The theoretical framework for the dissertation is to apply a biopsychosocial approach to understanding, assessment and treatment of patients with a substance use disorder. While this is the consensus reached in the field, different approaches still exist. There is a necessity to examine the history of the development of the concept of addiction to the substance use disorder definition we see and use today, to understand how the biopsychosocial approach emerged as the consensus in the field. The shift from a moral model to medical approach is vital to the understanding of the concept of the disorder and treatment of it. In addition, the main diagnostic and classification systems that Norway and the ASAM criteria uses when classifying substance use disorders will be discussed. This study was initiated by the region itself in light of the need for harmonising the regions’ assessment practices and investigating the prevalence of service need in the region. Because ASAM criteria software version is based on the DSM-IV criteria and follows a biopsychosocial approach to substance use disorder, this approach was deemed appropriate. In addition it is the only tool that can give automatic treatment recommendations on LOC placement based on over 6000 calculations. In need of translation and because it was a revised second edition, the criteria underwent validation testing on Norwegian substance use disordered population even though validation testing from USA provides support for the use of the criteria. ASAM criteria is a computer-assisted structured interview and clinical decision support programme that implements validated tools including the Addiction Severity Index and measures biopsychosocial conditions to match patients to an optimal LOC. Paper I assessed patients seeking help for substance use disorders in order to determine the ASAM Criteria’s predictive validity in terms of treatment outcomes among matched and mismatched patients. At post-test, patients who had received matched treatment based on the ASAM recommendation reported less use of alcohol and cannabis versus undermatched patients. Overmatched patients had no better outcomes than matched patients; in some cases no change occurred or a more intensive LOC was recommended at post-test. Consistent with prior studies, the ASAM Criteria Software Norwegian version demonstrates elements of predictive validity for determining intensity of LOC placement using all three prospectively planned measures. Paper II examined the discrepancies between ASAM Criteria LOC recommendations and Treatment-as-Usual, along with the software’s ability to clinically distinguish between patients with different LOC to determine convergent validity. The discrepancies found are in line with previous research: the more intensive recommendation by ASAM yielded better outcomes three months after for the matched group. The ability of the ASAM Criteria to clinically distinguish between the different LOC lends support for the software’s convergent validity. This ability to distinguish by severity was taken further in the third paper which also examined the programme’s Dual Diagnosis taxonomy, incorporated in the second revised version to assess patients’ need for more specialised programmes for co-occurring psychiatric disorders. We aimed to study the prevalence of co-occurring disorders programme recommendations and ASAM Criteria convergent validity in terms of locating patients with co-occurring disorders and discriminating between severities among those who received more intense recommendations. The results are in line with previous research with the use of these criteria, and the different recommendations show differences in characteristics, severity and outcomes. The higher the recommendation, the more psychiatric severity seen among the patients recommended for them. Significant differences were seen in both characteristics and severity. The results show a high prevalence of dual diagnosis programme recommendations in this region and characteristically clinical meaningful differences between the different recommendations. The new version of ASAM Criteria Software Dual Diagnosis taxonomy convergent validity is supported by the results. The successful translation and software testing in Norway should encourage larger studies – preferably across nations and treatment system – seeking higher power with larger subsamples across primary drug of choice and match/mismatched conditions

Facilitators and barriers for adolescents´ participation in nature-based activities : a scoping review

Bakgrunn: Gjennom tenårene er trenden at ungdom faller fra organiserte fritidsaktiviteter, og er i mindre kontakt med naturomgivelser. Samtidig øker forekomsten av psykiske plager og lidelser hos ungdom. Det er vist at deltakelse i friluftsliv har sammenheng med ungdoms fysiske aktivitetsnivå samt mentale utvikling, og opphold i naturlige omgivelser kan gi restorative opplevelser som forebygger psykiske plager. Naturopplevelser trenger ikke å koste mye og nærfriluftsliv kan gi de umotiverte og lite aktive et lavterskeltilbud, noe som er i tråd med prinsippene for det systematiske folkehelsearbeidet. For å kunne tilrettelegge for ungdoms deltakelse i friluftsliv på en bedre måte er det derfor nødvendig å få mer innsikt i deres egne opplevelse av hva som fasiliteter og hindrer slik deltakelse. Hensikt: Hensikten med forskningsprosjektet er å gi en mer samlet forståelse av hvorfor ungdom mellom 10-20 år deltar eller ikke deltar i friluftsliv, fra deres eget perspektiv. Problemstillingen er: «Hva vet vi fra eksisterende litteratur om ungdoms selvrapporterte fasilitatorer og barrierer for å delta i friluftsliv?». Målet er å få økt innsikt i ungdoms egne opplevelser slik at effektive tiltak for å øke deres deltakelse i friluftsliv kan iverksettes. Metode: Scoping review ble benyttet som metode for å kartlegge kompleksiteten ved eksisterende kunnskap som finnes om friluftsliv hos ungdom og syntetisere dette, i tillegg til å kunne identifisere kunnskapshull om temaet. Det ble gjennomført litteratursøk i tre databaser som resulterte i totalt 3083 treff, hvor 24 unike studier til slutt ble inkludert. Funnene ble syntetisert ved hjelp av narrativ og datastyrt teknikk, og dataene ble systematisert etter en sosioøkologisk tilnærming som resulterte i en determinantmodell for deltakelse i friluftsliv. Hovedfunn: Forskningsprosjektet har gitt økt innsikt i ungdoms selvrapporterte fasilitatorer og barrierer for deltakelse i friluftsliv, samtidig som noen kunnskapshull er identifisert. Hovedtyngden av funn dreier seg om ustrukturerte aktiviteter i nærfriluftslivet. Funnene viser at ungdoms deltakelse i friluftsliv påvirkes av individuelle faktorer som for eksempel alder, kjønn, opplevd trygghet samt personlige opplevelser og behov, som er knyttet til sosiale omgivelser som for eksempel venner, sosial støtte, foreldrerestriksjoner og menneskelige trusler. Videre påvirkes dette av nærhet og tilgjengelighet av egnede og godt vedlikeholdte friluftslivsfasiliteter i de bygde omgivelsene. I tillegg spiller naturlige omgivelser som for eksempel værforhold inn på hvorfor ungdom deltar eller ikke deltar i friluftsliv. Det trengs mer forskning på temaet for skandinaviske forhold, deltakelse i friluftsliv langt fra hjemmet og på hvordan kulturelle faktorer henger sammen med problemstillingen.Background: Individuals tend to drop out from organized leisure activities during adolescence, and in general adolescents spend less time in natural environments. At the same time, the prevalence of psychological complaints and mental health disorders is increasing in the adolescent population. Research has shown that participation in nature-based activities is related to adolescents’ level of physical activity as well as mental development, and the presence of natural surroundings can provide restorative experiences that prevent psychological complaints. Nature experiences do not have to be expensive and nature-based activities close to home can give the unmotivated and inactive adolescents a low-threshold offer, which is in line with the principles of systematic public health work. To be able to facilitate participation in nature-based activities throughout adolescence in a better way, it is therefore necessary to gain more insight into adoleVcenWV’ own experience and perceptions of what promotes and hinder such participation. Purpose: The purpose of this research project is to provide a more comprehensive and synthesized understanding of why adolescents between the ages of 10-20 years participate or do not participate in nature-based activities, from their own perspective. The research question is: What do we know from the existing literature about adolescents’ self-reported facilitators and barriers to participate in nature-based activities? The aim is to gain increased insight into adolescents’ own experiences so that effective actions can be implemented to increase their participation in nature-based activities. Method: A scoping review was conducted both to map and synthesize the complexity of existing knowledge about nature-based activities and adolescents, and to identify knowledge gaps on the topic. Literature searches were carried out in three databases. This resulted in a total of 3083 search results, of which 24 unique studies were eventually included. The data were synthesized using narrative and editing analysis style, and the findings were systematized according to a socio-ecological approach which resulted in a determinant model for participation in nature-based activities. Main findings: The research project has provided increased insight into adolescents’ self-reported facilitators and barriers for participation in nature-based activities, and some knowledge gaps have been identified. The majority of findings concerns unstructured nature-based activities close to home. The findings show that adolescents’ participation in nature-based activities is influenced by individual factors such as age, gender, perceived safety and personal experiences and needs, which are linked to social environments such as friends, social support, parental restrictions and human threats. Furthermore, this participation in nature-based activities is influenced by proximity and accessibility to applicable and well-maintained nature-based facilities in the built environment. Additionally, aspects related to the natural environments, such as weather conditions, seem to play a role for why adolescents participate or do not participate in nature-based activities. More research is needed on the topic for Scandinavian conditions, participation in nature-based activities far from home and on how cultural factors are related to the issue.M-FO

Fasilitatorer og barrierer for ungdoms deltakelse i friluftsliv : en scoping review

Bakgrunn: Gjennom tenårene er trenden at ungdom faller fra organiserte fritidsaktiviteter, og er i mindre kontakt med naturomgivelser. Samtidig øker forekomsten av psykiske plager og lidelser hos ungdom. Det er vist at deltakelse i friluftsliv har sammenheng med ungdoms fysiske aktivitetsnivå samt mentale utvikling, og opphold i naturlige omgivelser kan gi restorative opplevelser som forebygger psykiske plager. Naturopplevelser trenger ikke å koste mye og nærfriluftsliv kan gi de umotiverte og lite aktive et lavterskeltilbud, noe som er i tråd med prinsippene for det systematiske folkehelsearbeidet. For å kunne tilrettelegge for ungdoms deltakelse i friluftsliv på en bedre måte er det derfor nødvendig å få mer innsikt i deres egne opplevelse av hva som fasiliteter og hindrer slik deltakelse. Hensikt: Hensikten med forskningsprosjektet er å gi en mer samlet forståelse av hvorfor ungdom mellom 10-20 år deltar eller ikke deltar i friluftsliv, fra deres eget perspektiv. Problemstillingen er: «Hva vet vi fra eksisterende litteratur om ungdoms selvrapporterte fasilitatorer og barrierer for å delta i friluftsliv?». Målet er å få økt innsikt i ungdoms egne opplevelser slik at effektive tiltak for å øke deres deltakelse i friluftsliv kan iverksettes. Metode: Scoping review ble benyttet som metode for å kartlegge kompleksiteten ved eksisterende kunnskap som finnes om friluftsliv hos ungdom og syntetisere dette, i tillegg til å kunne identifisere kunnskapshull om temaet. Det ble gjennomført litteratursøk i tre databaser som resulterte i totalt 3083 treff, hvor 24 unike studier til slutt ble inkludert. Funnene ble syntetisert ved hjelp av narrativ og datastyrt teknikk, og dataene ble systematisert etter en sosioøkologisk tilnærming som resulterte i en determinantmodell for deltakelse i friluftsliv. Hovedfunn: Forskningsprosjektet har gitt økt innsikt i ungdoms selvrapporterte fasilitatorer og barrierer for deltakelse i friluftsliv, samtidig som noen kunnskapshull er identifisert. Hovedtyngden av funn dreier seg om ustrukturerte aktiviteter i nærfriluftslivet. Funnene viser at ungdoms deltakelse i friluftsliv påvirkes av individuelle faktorer som for eksempel alder, kjønn, opplevd trygghet samt personlige opplevelser og behov, som er knyttet til sosiale omgivelser som for eksempel venner, sosial støtte, foreldrerestriksjoner og menneskelige trusler. Videre påvirkes dette av nærhet og tilgjengelighet av egnede og godt vedlikeholdte friluftslivsfasiliteter i de bygde omgivelsene. I tillegg spiller naturlige omgivelser som for eksempel værforhold inn på hvorfor ungdom deltar eller ikke deltar i friluftsliv. Det trengs mer forskning på temaet for skandinaviske forhold, deltakelse i friluftsliv langt fra hjemmet og på hvordan kulturelle faktorer henger sammen med problemstillingen

Hvordan har Forsvarets ledelsesideal endret seg i rammen av tillitt og kontroll i nyere tid?

Norsk sammendrag Denne oppgaven omhandler endringer i Forsvarets ledelsesidealer over tid i rammen av begrepene tillitt og kontroll. Spesielt rettes fokus på hvilken effekt endringsdriverne traumatiske hendelser, forvaltningspolitisk utvikling og internasjonalisering har hatt/påvirket utviklingen. Oppgaven bygger på en tanke om at disse tre har hatt stor påvirkning på utviklingen av ledelsesidealene og søker å forstå hvorvidt disse har forsterket hverandre, eller trukket i ulik retning. Gjennomgående i oppgaven nyttes de ulike utgavene/revisjonene av Forvarssjefens grunnsyn på ledelse, som en tidsvitnebeskrivelse av ulike ledelsesidealer i aktuelle tidsperiode. De tre endringsdriverne er representert ved henholdsvis; Vassdalen-ulykken, reformer inspirert av New Public Management, og endringen i Forsvarets internasjonale innsats, fra en vekting mot FN og fredsbevarende, til en vekting mot NATO og fredsopprettende. For å identifisere mulige sammenhenger mellom endringsdriverne, og hvordan disse har påvirket ledelsesidealene i Forsvaret, trekkes det på aspekter fra organisasjonsteorier om instrumentelle og institusjonelle syn på organisasjoner og endring. En rød tråd har gått i diskusjonen om Forsvarets ledelsesideal. Fra tidlig 1900-tallet frem til nyere tids Norske adopsjon av Auftragstaktik gjennom Oppdragsbasert ledelse. I denne perioden fungerte Vassdalen-ulykken som en katalysator for hurtigere endring. Videre identifiseres komponenter fra New Public Management som forsterker naturlig utvikling, men også inneholder forvaltningspolitiske krav som bryter med den mer rendyrkede militære ledelsesfilosofien

HRQoL and its association to clinical severity and treatment needs

Health Related Quality of Life (HRQoL) has received more attention recently; however, there is still limited knowledge of the relationship between HRQoL in comorbid samples, and service needs within this population. The rate for additional psychological issues and the drop-out rate is known and reported high and investigating HRQoL might provide more answers on needs within this population. A multi-cite prospective study including 175 treatment seeking individuals from mid-Norway was studied at baseline and three months after treatment initiation. Data were gathered from a structured ASAM interview and a self-report survey covering the SF-36 items regarding HRQoL. The results showed significantly lower HRQoL scores among treatment seeking individuals with a substance use disorder, compared with scores from the general population. Higher psychological burden was associated with lower HRQoL at baseline. At follow-up HRQoL increased and significantly for Physical Function. In addition, the individuals with the lowest HRQoL scores on psychological items received more psychiatric program recommendation by ASAM. The high drop out among those who scored the lowest on HRQoL is of clinical importance. Both SF-36 and ASAM interview based software are considered to be valid and useful tools to retrieve patient centered and relevant information and should be used in a clinical setting to support individually tailored treatment. This is an Accepted Manuscript of an article published by Taylor & Francis, available online: http://www.tandfonline.com

Hvordan kan friluftsliv ha betydning for å mestre hverdagen for mennesker med psykiske helseutfordringer?

Sammendrag Tittel: Hvordan kan friluftsliv ha betydning for å mestre hverdagen for mennesker med psykiske helseutfordringer? Bakgrunn: Halvparten av den norske befolkningen vil oppleve psykisk lidelse/plage i livet. De vanligste plagene er angst og depresjon. Psykisk helse og friluftsliv er et tema som er dagsaktuelt. Vi vil med denne oppgaven se hvilken betydning friluftsliv har for hverdagen for de med psykiske helseutfordringer. Metode: Oppgaven er inspirert av Scoping Review, hvor teori og litteratursøk skal hjelpe å besvare problemstillingen. Litteratursøk ble gjennomført i Idunn, PubMed, Oria og PsycINFO. Resultat: En sammenfatning av funnene resulterte i kategoriene: tilknytning til naturen, selvtillit, mestring, velvære og sosialt samspill. Konklusjon: Gjennom litteratursøk, teorier og erfaringer, har vi kommet frem til at friluftsliv kan ha en betydning for mestring i hverdagen for mennesker med psykiske helseutfordringer. Resultatene fra artiklene viser at å mestre aktiviteter i friluftsliv har overføringsverdi til mestring i hverdagen. Nøkkelord: friluftsliv, psykisk helseutfordring, mestring og hverda

Assessing health service satisfaction among users with substance use disorders within the municipalities in Norway

Abstract Background The purpose of this study was to assess what is associated with health service satisfaction among adults with a substance use disorder receiving services provided within different municipalities in Norway. An additional aim was to examine demographic and municipality characteristics, mental health, and types of substance use associated with health service satisfaction. Method A cross-sectional partial explorative study was executed in 2017 among 491 service users with substance use disorders from 20 randomly selected municipalities. The sample consisted of 70% males. The sample majority were single and unemployed, and their main sources of healthcare were the general practitioner (78%), The Norwegian Labor and Welfare Administration (72%), and addiction counsellors (62%). Results Overall satisfaction was negatively associated with age, size of municipality, Global Severity Index (GSI) and illicit substance use during the last 12 months. Satisfaction with practical help, such as housing, economy, work and education, was negatively associated with GSI and positively associated with onset of first alcohol intoxication. Satisfaction with personnel was positively associated with onset of first alcohol intoxication and negatively associated with municipality size, GSI and illicit use the last 12 months. The results showed that more than half of the respondents (54%) to a large or great extent were satisfied with the overall services provided. The services they were less satisfied with were related to housing, economy, getting started with exercise and establishing a social network. Conclusion The results show areas associated with satisfaction and domains where the municipalities can improve their services to meet the users’ needs and increase service satisfaction